1. www.OncologyEducation.ca A randomized trial of prophylactic cranial irradiation (PCI) versus no PCI in extensive disease small cell lung cancer after a response to chemotherapy (EORTC 08993-22993) Authors: Slotman et al. LBA #4 Reviewer: Dr Randeep Sangha Date posted: June 21, 2007

2. www.OncologyEducation.ca Background High incidence of brain metastases (BM) in SCLC Prophylactic cranial irradiation (PCI) in limited disease (LD) SCLC reduces risk of brain metastases and improves survival –PCI used for patients in complete remission –Brain metastases incidence reduced 58.6% vs 33.3% with PCI at 3 yrs –Survival increases 15.3% vs 20.7% with PCI at 3 yrs Auperin et. al. NEJM 1999;341:476-84

3. www.OncologyEducation.ca Study Design Study Question –Does PCI have a role in patients with extensive disease (ED) SCLC ? Study Population –286 patients with ED-SCLC accrued between February 2001 to March 2006 Endpoints –Primary Endpoint Cumulative incidence of symptomatic BM –Secondary Endpoints Failure free survival (FFS) Overall Survival (OS)

4. www.OncologyEducation.ca R Treatment A: PCI (20-30 Gy in 5-12 fr) Treatment B: No PCI ED-SCLC with no prior RT to head and neck and no prior malignancy

5. www.OncologyEducation.ca PCINo PCIp-value FFS at 6mos (%) 23.415.5p= 0.0218 1 yr OS (%) 27.113.3p= 0.0033 RESULTS

6. www.OncologyEducation.ca Results 286 patients with any response to chemotherapy were randomized equally to each arm (PCI vs no PCI) Baseline characteristics similar PCI arm –75.5% with persistent primary thoracic disease –69.2% with distant metastatic disease No PCI arm –76.9% with persistent primary thoracic disease –72.7 distant metastatic disease

7. www.OncologyEducation.ca Study Commentary PCI significantly reduces the risk of symptomatic BM PCI significantly prolongs FFS and OS PCI is well tolerated and does not adversely influence global quality of life (QoL)/health status PCI should be considered in all ED-SCLC patients who have had any response (PR,CR) to initial chemotherapy

8. www.OncologyEducation.ca Bottom Line for Canadian Medical Oncologists  A well-designed study demonstrating the benefits of PCI in ED-SCLC patients  ED-SCLC patients who respond to chemotherapy, and have a good performance status, should be referred for PCI